About this Publication
In its 2008 submission to the Darzi healthcare review, 'Our NHS, our future', the ADSHG recommended the establishment of regional (tertiary) centres of expertise in adrenal medicine and effective partnerships between tertiary centres and local GPs.
Core recommendations.
Regional (tertiary) centres of expertise in adrenal medicine, able to offer:
1. Optimisation of steroid replacement therapy by monitoring:
- Mineralcorticoid replacement (plasma renin, serum electrolytes)
- Glucocorticoid replacement (hydrocortisone day curve)
- DHEA replacement (DHEA-S, testosterone and oestrogen)
- Calcium and other indicators of bone turnover.
2. Life-long monitoring for the anticipated development of associated conditions. Frequently:
- Hypothyroidism or Graves disease
- Diabetes
- Vitamin B12 deficiency
- Coeliac disease or other autoimmune conditions.
3. Patient education in prevention and treatment of adrenal emergencies, including training in self-injection.
4. Guidance to the patient’s other medical specialists regarding steroid cover for surgical and dental procedures
5. Effective partnerships between tertiary centres and local GPs